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Preview ACLS Algorithm

Preview ACLS Algorithm

Preview ACLS Algorithm

Protocols for Adult Advanced Cardiac Life Support

Protocols for Adult Advanced Cardiac Life Support   Recommendations 1. That the Adult ACLS algorithm be
 

Recommendations

1.

That the Adult ACLS algorithm be used as a tool to manage all adults who require advanced life support.

2.

Good quality CPR and reducing time to defibrillation are the highest priorities in resuscitation from sudden cardiac arrest.

3.Rescuers should aim to minimise interruptions to CPR during any ACLS intervention.

What seems to work?

Performing ACLS correctly is associated with an improvement in outcome

Compared guideline adherence for survivors vs. non-survivors

75 survivors

75 non-survivors

Survivors older and with more cormorbidities

Resuscitation. 2013;85:82-87
• Each 10% improvement in adherence results in a ˜30% increase in ROSC. Resuscitation. 2013;85:82-87

Each 10% improvement in adherence results in a ˜30% increase in ROSC.

• Each 10% improvement in adherence results in a ˜30% increase in ROSC. Resuscitation. 2013;85:82-87

What is Recommended

Defibrillation

Chest Compressions

Oxygenation

Medications

Procedures

Chest Compressions

Place patient on a firm surface

Backboard

Deflation of air mattress

Had in the middle of the chest

5 cm of depression

Allow complete recoil

Lifting the hand completely of the chest can improve recoil

CPR

Depth: 5cm

Rate: 100-120bpm

Minimise interruptions

Cycle every 2 minutes or more frequently of required

ETCO2 < 10mmHg = inadequate compressions

• Cycle every 2 minutes or more frequently of required • ETCO2 < 10mmHg = inadequate

Monomorphic VT

Monomorphic VT

Polymorphic VT

Polymorphic VT

Polymorphic VT/TdP

Polymorphic VT/TdP

VF

VF

Shockab

Shockab le CPR 2 minutes CPR for 2 minutes 1mg Adrenaline IV/IO (1 in 1000) Then

le

CPR 2 minutes CPR for 2 minutes 1mg Adrenaline IV/IO (1 in 1000) Then every
CPR 2
minutes
CPR for 2 minutes
1mg Adrenaline
IV/IO (1 in 1000)
Then every 2 nd
cycle
CPR for 2
minutes
Amiodarone

300mg IV/IO

• 200 J shock

(biphasic)

Recommended it is reasonable to increase energy level for

subsequent shocks.

Non shockable
Non shockable
Non shockable
Non shockable
Non shockable
Non
shockable
1mg Adrenaline IV/IO (1 in 1000)
1mg Adrenaline
IV/IO
(1 in
1000)
CPR 2 minutes CPR 2 minutes
CPR 2
minutes
CPR 2
minutes

Reversible causes

4 H’s & 4 T’s

Hypoxaemia

Hypovolaemia

Hyper/hypokalaemia & metabolic disorders

Hypo/hyperthermia

Tension pneumothorax

Tamponade

Toxins / poisons / drugs

Thrombosis-pulmonary / coronary

Cardioversion

Rhythm

Energy level (biphasic)

Atrial fibrillation

120-200 J (synchronised)

Atrial flutter

50-100 J (synchronised)

SVT

50-100 J (synchronised)

Pulsed VT

100

J (synchronised)

VF/Pulseless VT

200

J (consider increasing if

unsuccessful)

Algorithms for Advanced Cardiac Life Support 2018

Summary

• All cardiac arrests should follow the ALS algorithm

• Good quality CPR with minimal interruptions including

• Resuscitate with 100% O2

• Early defibrillation

• Consider higher energy levels if 1 st shock unsuccessful

Thank You

Thank You